Clinical results of distal anterior tibial tendon decompression

Cock, Laurens De; Eynde, Elke Van; Vandeputte, Geoffroy

doi:10.1016/j.fas.2020.10.012

Cited by 3 publications

(10 citation statements)

References 17 publications

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“…Underlying midfoot arthritis may contribute to this process and can present with similar symptoms. 3,5,7,10,11,14,[17][18][19]22,[26][27][28] Although DTAT seems to be more common than reported, patient inclusion was slow. Possible explanations are the COVID-19 pandemic and its repercussions, as nonurgent health care was interrupted between March 2020 and May 2021, as well as lack of awareness for the pathology with general practitioners and orthopaedic surgeons.…”

Section: Discussionmentioning

confidence: 87%

“…Underlying midfoot arthritis may contribute to this process and can present with similar symptoms. 3,5,7,10,11,14,17-19,22,26-28…”

Section: Discussionmentioning

confidence: 99%

“…3,18,27 Imaging techniques such as ultrasonographic and magnetic resonance can be used to confirm a clinically suspected tendinopathy. 3,7,10,11,15,18,22 The majority of cases can be managed nonoperatively, although little consensus exists on which treatment protocol is most effective. 11,[17][18][19] Nonoperative strategies range from minimal adaptive measures such as insoles with medial arch support and rehabilitation, to temporary immobilization in a cast or constraint ankle movement (CAM) orthosis and corticosteroid infiltrations.…”

Section: Introductionmentioning

confidence: 99%

“…1,2,8,12,20,21 Patients who failed conservative therapy may ultimately be treated surgically, and different techniques with good patient satisfaction have been described. 5,7,9,10,13,15,18,26 Although surgical intervention remains an option after failed conservative management, literature and common clinical practice recommend that nonoperative treatment should always be the first choice. Nonetheless, retrospective studies have reported varying results following nonoperative management, ranging from ca.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Platelet-Rich Plasma Infiltration and Weightbearing Cast Immobilization in Distal Tibialis Anterior Tendinopathy: A Prospective Cohort Study

Desomer,

van Beek,

Van Riet

et al. 2023

Foot Ankle Int.

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Background: Distal tibialis anterior tendinopathy (DTAT) is a chronic condition that may lead to functional impairment and secondary forefoot deformities when left untreated. Current clinical practice is mainly guided by case reports and small retrospective case series; little consensus exists on which treatment protocol is most effective. This study aims to assess a conservative treatment for DTAT consisting of PRP infiltration and walking cast immobilization. Methods: This prospective study included 18 feet in 18 patients, recruited between September 2020 and September 2022 at a single institution. Ultrasonography was performed; leukocyte-poor PRP was infiltrated around the tibialis anterior tendon insertion. Walking cast immobilization was used for 3 weeks after infiltration, followed by eccentric exercises of the DTAT, and gastrocnemius-soleus muscle complex stretching. Clinical findings, visual analog scale (VAS), Foot Function Index (FFI), and American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scores were recorded at inclusion, and 6 and 12 weeks after PRP infiltration. Minimal clinically important difference (MCID) limits were researched to assess clinical relevance of statistical outcomes. Means were determined for age, sex, and body mass index (BMI). One-way repeated measures ANOVA was performed over time for FFI, AOFAS, and VAS scores. Results: Mean age was 65 years with a mean BMI of 25. Tendon thickening and hypoechogenicity were the most commonly reported ultrasonographic findings. Significant improvement from baseline VAS (VASrest: 4.71 ± 2.7, VASactivity: 5.66 ± 2.5) to 12 weeks follow-up (VASrest: 2.14 ± 2.7, VASactivity: 3.34 ± 2.5) was found. Both AOFAS and FFITotal improved significantly from baseline (AOFAS: 66.9 ± 3.3, FFITotal: 32.9 ± 3.3) to 6-week follow-up (AOFAS6w: 79.4 ± 3.3, P = .019; FFITotal: 19.4 ± 3.3, P = .011). No statistically significant further improvement was found at 12 weeks compared to 6 weeks’ follow-up. Two (11%) patients chose operative treatment because of persisting symptoms. Conclusion: We found that PRP infiltration with walking cast immobilization as a first-line treatment was associated with general early symptom improvement. Level of Evidence: Level IV, case series.

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Section: Discussionmentioning

confidence: 87%

“…Underlying midfoot arthritis may contribute to this process and can present with similar symptoms. 3,5,7,10,11,14,17-19,22,26-28…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Outcomes of Platelet-Rich Plasma Infiltration and Weightbearing Cast Immobilization in Distal Tibialis Anterior Tendinopathy: A Prospective Cohort Study

Desomer,

van Beek,

Van Riet

et al. 2023

Foot Ankle Int.

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“…Indeed, a PubMed search identified 5 publications on DTAT since those I have mentioned. 2,3,5,6,11 Thus, it would appear that a limited literature review has been undertaken by Levitsky et al, 7 which in my view detracts from the merit of this otherwise interesting article.…”

mentioning

confidence: 87%

Letter Regarding: Risk Factors for Anterior Tibial Tendon Pathology

Beischer¹

2021

Foot Ankle Int.

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with interest the article "Risk Factors for Anterior Tibial Tendon (ATT) Pathology" by Levitsky et al. 7 This article reported on the 2 clinical presentations of ATT pathology in a series of 94 patients. The first entity, ATT rupture, is a condition that was reported as early as 1947 by Moberg, 9 and more than 70 case reports and series have been documented in the literature ever since, with the largest series of 19 ruptures in 18 patients reported by Sammarco et al. 10 In this series, males represented a small majority (58%) of cases, whereas in the series of 15 ruptures reported by Levitsky et al, 7 62% were in women. Thus, it would appear that for ruptures of the ATT, sex probably is not a risk factor.The entity of distal tibialis anterior tendinopathy (DTAT) without rupture was first described in the radiological literature by Mengiardi et al 8 in 2005 and the clinical features by Beischer et al 1 in 2009, who reported on a series of 29 patients (33 feet) in this journal. They reported that this clinical entity was predominantly seen in women (93% of cases), with the majority being overweight or obese. They described the Tibialis Anterior Passive Stretch (TAPS) test, which can be useful in diagnosing the condition. The operative management of DTAT was reported by our group in 2010 again in this journal. 4 Our results would support the statement that most patients with DTAT can be successfully managed with nonoperative therapy, although we have found a custom accommodative insole effective in the majority. We have found that some with night pain as a major symptom can find relief by wearing a rigid ankle foot orthosis while sleeping.In the cohort of 79 patients with DTAT reported by Levitsky et al, 7 81% were women, and an average body mass index of 27.2 kg/m 2 was reported for the entire cohort. Thus, their findings support those reported initially by our group, although this was not acknowledged by Levitsky et al. 7 Although the majority (64/79) of their patient cohort displayed features of DTAT, there was no reference to this entity in their bibliography, with all references being to the rupture of the ATT. Indeed, a PubMed search identified 5 publications on DTAT since those I have mentioned. 2,3,5,6,11 Thus, it would appear that a limited literature review has been undertaken by Levitsky et al, 7 which in my view detracts from the merit of this otherwise interesting article.

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Novel surgical management of tibialis anterior tendinosis using an anchor augment

2023

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Objective: The objective of this paper was to describe a surgical technique for the management of TA tendinosis: Debridement, repair, and augmentation with a suture anchor without tendon transfer. Methods: This is a retrospective case series including five patients managed surgically for TA tendinosis. If ≥ 30% of healthy tendon remains after debridement, the tendon is augmented with a suture anchor, with the suture incorporating the healthy tendon as acheckrein. Patient outcomes were assessed using the AOFAS midfoot, VAS Pain, and SEFAS score. Results: The mean AOFAS improved preoperatively from 37.0 (range 18–51) to 97.6 (range 95–100), the VAS pain score from 8.0 (range7–9) to 0.8 (range 0–1), and the mean SEFAS score at final follow-up was 43.8 (range 41–48). Conclusions: Tibialis anterior tendinosis is an uncommon degenerative process. Early diagnosis and appropriate management can prevent tendon rupture. This case series of debridement, repair, and augmentation with a suture anchor showed high patient satisfactionand good clinical outcomes without needing a tendon transfer. Level of Evidence III; Therapeutic Studies - Investigating the Results of Treatment; Retrospective Comparative Study

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Clinical results of distal anterior tibial tendon decompression

Cited by 3 publications

References 17 publications

Outcomes of Platelet-Rich Plasma Infiltration and Weightbearing Cast Immobilization in Distal Tibialis Anterior Tendinopathy: A Prospective Cohort Study

Outcomes of Platelet-Rich Plasma Infiltration and Weightbearing Cast Immobilization in Distal Tibialis Anterior Tendinopathy: A Prospective Cohort Study

Letter Regarding: Risk Factors for Anterior Tibial Tendon Pathology

Novel surgical management of tibialis anterior tendinosis using an anchor augment

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